Individual provider Active NPI

Krista Grantham, PA-C

  • Surgical Physician Assistant
  • San Antonio, TX
National Provider Identifier
1073920005
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA09328 Issued in TX
Practice address
133 Terrell Rd Unit 9
San Antonio, TX 78209-6329
Phone
(830) 221-6903
NPI assigned
Jul 22, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Surgical Physician Assistant 363AS0400X PA09328 TX Primary

Addresses

Primary practice location

133 Terrell Rd Unit 9
San Antonio, TX 78209-6329

Mailing address

PO Box 6141
San Antonio, TX 78209-0141
Phone (830) 221-6903

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141107001605 TX Practitioner - Physician Assistant 7517189483 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Texas Medical School at San Antonio, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Centers of TexasGroup PAC ID 0345772893, 2 clinicians

Practice addresses (Care Compare)

3619 Paesanos Pkwy
Suite 302
San Antonio, TX 78231-1259
Phone (210) 469-3830

Hospital & facility affiliations

  • Methodist Hospital Hospital, San Antonio, TX, CCN 450388

Merit-based Incentive Payment System (MIPS)

Final score
87.32 of 100Reported as group
Quality
75.23
Promoting interoperability
99
Improvement activities
40
Cost
76.31

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA09328TXMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Adam Bruggeman MD PLLC Physician Assistant Past Accepting new patients
Dr Bradley Shipman MD PLLC PastSince Jul 15, 2014 Accepting new patients
Elan Elite Surgical Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1073920005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6141",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782090141",
            "telephone_number": "830-221-6903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 TERRELL RD UNIT 9",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782096329",
            "telephone_number": "830-221-6903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANTHAM",
        "first_name": "KRISTA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-22",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA09328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.